Pre-operative Duplex and Intra-Operative Venography to Assess the Integrity of the Central Veins in Patients Undergoing Arteriovenous Fistulae

Document Type : Original Article

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Vascular Surgery Unit, Faculty of Medicine, Alexandria University, Egypt

Abstract

Introduction: Increasing the prevalence of End stage renal disease (ESRD) patients requiring hemodialysis has
resulted in increased dialysis access procedures performed by vascular surgeons. This should be preceded by
duplex examination to ensure central venous outflow. Central venous stenosis (CVS) is the most common cause
access failure.
Aim of work: Was to study incidence and characteristics of CVS among ESRD patients using preoperative duplex
“DUS” and intraoperative venography.
Patients and methods: Prospective study of 100 patients. Patients were excluded in cases of connective tissue
disorders, cardiac ejection fraction < 50%, contrast allergy, pregnancy or arterial insufficiency.
Pre-shunt duplex assessment and CVS was diagnosed by direct and indirect signs. Under Regional or Local
anesthesia, intraoperative venography as the vein was cannulated and imaged under C-arm fluoroscopy. If there
was no CVS, AVF was created, but if there was CVS, operation was aborted for elective management. Characteristics
of CVS was registered regarding characteristics (Stenosis or occlusion).
Results: Preoperative duplex and intraoperative venography were done to all patients to detect CVS. The new
arteriovenous access was done immediately in cases of free CVS. 24% of the patients had CVS by preoperative
duplex and 32% had CVS by duplex and venography and planned for further management. Unfortunately, 8
patients with duplex free of CVS appeared to have CVS by venography.
Conclusion: DUS is a very efficient tool in diagnosis of CVS or occlusion, but has a few fallacies and therefore
venography could be required.

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